Anaesthetic management of pacemaker implantation in a child with dilated cardiomyopathy and acquired complete atrioventricular heart block

We report a case of an 8-year-old girl who presented with syncopal attacks and a history of viral illness a month ago. On examination, she was conscious, oriented but had a heart rate of 42/min which was unresponsive to atropine. She was started on dobutamine and isoproterenol. Electrocardiography and echocardiography revealed complete heart block with moderate tricuspid regurgitation, dilated cardiomyopathy and low ejection fraction. Patient was planned for urgent permanent pacemaker insertion. General anaesthesia was administered with endotracheal tube and controlled ventilation using fentanyl, ketamine and pancuronium. For patient safety, invasive arterial monitoring was instituted and external pacing was kept standby. Transvenous pacemaker leads were implanted onto the right ventricular wall through the left subclavian vein.